A 3-year-old girl presents with her second episode of febrile UTI in 8 months. Culture grows >10⁵ CFU/mL E. coli sensitive to trimethoprim-sulfamethoxazole. What investigation is indicated after completing this acute treatment, according to evidence-based guidelines?
- A Renal ultrasound and DMSA scan after second febrile UTI to detect renal scarring ✓
- B Micturating cystourethrogram (MCUG) after first UTI in all girls
- C MCUG after first UTI in girls only if renal ultrasound shows abnormality
- D No further imaging needed after a second UTI if renal ultrasound is normal
Correct answer: A. Renal ultrasound and DMSA scan after second febrile UTI to detect renal scarring
Explanation
Current NICE (2007/2022) and Indian guidelines recommend renal ultrasound for all children with first febrile UTI. For recurrent UTIs (second febrile UTI), DMSA renal scintigraphy is recommended at least 4–6 months after acute infection to detect cortical scarring (reflux nephropathy). MCUG/VCUG is reserved for children with abnormal ultrasound, unusual organisms, or DMSA scarring, to detect vesicoureteral reflux (VUR). Routine MCUG after first UTI without ultrasound abnormality is no longer recommended in girls per current evidence to avoid radiation and distress.
Reference: Ghai Essential Pediatrics, 10th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.